Does lower-limb asymmetry increase injury risk in sport? A systematic review

2021 ◽  
Vol 49 ◽  
pp. 204-213
Author(s):  
Mark Helme ◽  
Jason Tee ◽  
Stacey Emmonds ◽  
Chris Low
Keyword(s):  
Systematic Review ◽  
Lower Limb ◽  
Injury Risk ◽  
Limb Asymmetry

scholarly journals The Influence of Exercise-Induced Fatigue on Inter-Limb Asymmetries: a Systematic Review

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Jessica Heil ◽  
Florian Loffing ◽  
Dirk Büsch
Keyword(s):  
Systematic Review ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Physical Load ◽  
Future Research ◽  
Before And After ◽  
Isokinetic Strength Testing ◽  
Anterior Cruciate ◽  
Limb Asymmetry ◽  
Exercise Induced

Abstract Background Non-contact injuries such as anterior cruciate ligament ruptures often occur during physical load toward the end of a match. This is ascribed to emerging processes due to exercise-induced fatigue. Moreover, non-contact injuries often occur during dynamic actions such as landing or cutting movements. Inter-limb asymmetries are suggested as one possible cause for those injuries based on findings indicating that asymmetries between limbs are associated with a higher injury risk. Hence, assessing inter-limb asymmetry during physical load in the condition of exercise-induced fatigue is warranted to identify potentially relevant precursors for non-contact injuries. Objective The objective of this study was to overview the current state of evidence concerning the influence of exercise-induced fatigue on inter-limb asymmetries through a systematic review. Methods A systematic literature search was conducted using the databases Web of Science, Scopus, PubMed, SURF, and SPONET to identify studies that assessed inter-limb asymmetries of healthy people, calculated with an asymmetry equation, before and after, or during a loading protocol. Results Thirteen studies were included in the systematic review. The loading protocols involved running, race walking, jumping, squatting, soccer, rowing, and combinations of different exercises. Moreover, different tasks/procedures were used to assess inter-limb asymmetries, e.g., squats, single-leg countermovement jumps, gait analysis, or isokinetic strength testing. The results seem to depend on the implemented loading protocol, the tasks/procedures, and the measured parameters. Conclusions Future research needs more systematization and consistency, assessing the effect of exercise-induced fatigue on inter-limb asymmetries. Moreover, the emergence of inter-limb asymmetries should be regarded in the context of sport-specific movements/tasks. Testing before, after, and during a physical loading protocol is advisable to consider the influence of exercise-induced fatigue on sport-specific tasks and to identify the possible mechanisms underlying load-dependent inter-limb asymmetries with regard to risk of non-contact injury.

scholarly journals The Calculation, Thresholds and Reporting of Inter-Limb Strength Asymmetry: A Systematic Review

2021 ◽  
pp. 594-617
Author(s):  
Amy O. Parkinson ◽  
Charlotte L. Apps ◽  
John G. Morris ◽  
Cleveland T. Barnett ◽  
Martin G. C. Lewis
Keyword(s):  
Systematic Review ◽  
Injury Risk ◽  
Asymmetry Index ◽  
Normative Values ◽  
Original Research ◽  
Approximate Symmetry ◽  
Scientific Databases ◽  
Strength Asymmetry ◽  
Limb Asymmetry ◽  
And Performance

The prevalence of inter-limb strength differences is well documented in the literature however, there are inconsistencies related to measurement and reporting, and the normative values and effects associated with inter-limb asymmetry. Therefore, the aims of this systematic review were to: 1) assess the appropriateness of existing indices for the calculation of asymmetry, 2) interrogate the evidence basis for literature reported thresholds used to define asymmetry and 3) summarise normative levels of inter-limb strength asymmetry and their effects on injury and performance. To conduct this systematic review, scientific databases (PubMed, Scopus, SPORTDiscus and Web of Science) were searched and a total of 3,594 articles were retrieved and assessed for eligibility and article quality. The robustness of each identified asymmetry index was assessed, and the evidence-basis of the identified asymmetry thresholds was appraised retrospectively using the references provided. Fifty-three articles were included in this review. Only four of the twelve identified indices were unaffected by the limitations associated with selecting a reference limb. Eighteen articles applied a threshold to original research to identify “abnormal” asymmetry, fifteen of which utilised a threshold between 10-15%, yet this threshold was not always supported by appropriate evidence. Asymmetry scores ranged between and within populations from approximate symmetry to asymmetries larger than 15%. When reporting the effects of strength asymmetries, increased injury risk and detriments to performance were often associated with larger asymmetry, however the evidence was inconsistent. Limitations of asymmetry indices should be recognised, particularly those that require selection of a reference limb. Failure to reference the origin of the evidence for an asymmetry threshold reinforces doubt over the use of arbitrary thresholds, such as 10-15%. Therefore, an individual approach to defining asymmetry may be necessary to refine robust calculation methods and to establish appropriate thresholds across various samples and methodologies that enable appropriate conclusions to be drawn.

scholarly journals Association between Inter-Limb Asymmetries in Lower-Limb Functional Performance and Sport Injury: A Systematic Review of Prospective Cohort Studies

2022 ◽  
Vol 11 (2) ◽  
pp. 360
Author(s):  
Yanfei Guan ◽  
Shannon S. D. Bredin ◽  
Jack Taunton ◽  
Qinxian Jiang ◽  
Nana Wu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Lower Limb ◽  
Prospective Cohort ◽  
Sport Injury ◽  
Functional Performance ◽  
Dynamic Balance ◽  
Prospective Cohort Studies ◽  
Increased Risk ◽  
Limb Asymmetry

Background: Inter-limb asymmetry in lower-limb functional performance has been associated with increased risk of sport injury; however, findings are not always consistent. Purpose: To conduct a systematic review on whether inter-limb asymmetry in lower-limb functional performance can predict sport injury. Methods: Four electronic databases (MEDLINE, EMBASE, Web of Science, and SportDiscus) were systematically searched for prospective cohort studies reporting the association between inter-limb asymmetry in lower-limb functional performance and sport injury. Results: A total of 28 prospective cohort studies were included in the analyses. Collectively, the findings were highly inconsistent, and a clear statement on the association between each asymmetry and sport injury was difficult. Conclusions: Highly inconsistent findings make it difficult to create clear recommendations on the relationship between the inter-limb asymmetry in lower-limb functional performance (power, muscle flexibility, and dynamic balance) and sport injury. The influence of potential factors (selection of tests/parameters, participant characteristics, definition of injury, and ways of calculating asymmetry) should be considered when using previous findings.

scholarly journals Perceptual-cognitive Function and Unplanned Athletic Movement Task Performance: A Systematic Review

2020 ◽  
Author(s):  
Jan Wilke ◽  
David Groneberg ◽  
Winfried Banzer ◽  
Florian Giesche
Keyword(s):  
Systematic Review ◽  
Cognitive Function ◽  
Task Performance ◽  
Lower Limb ◽  
Injury Risk ◽  
Literature Search ◽  
Future Research ◽  
Functional Safety ◽  
Study Quality ◽  
Cutting Direction

The performance of choice-reaction tasks during athletic movement has been demonstrated to evoke unfavorable lower limb biomechanics. However, the mechanism of this observation is unknown. We conducted a systematic review examining the association between 1) the biomechanical and functional safety of unplanned sports-related movements (e.g. jumps/runs with spontaneously indicated landing leg/cutting direction) and 2) markers of perceptual-cognitive function (PGF). A literature search in three databases (Pubmed, ScienceDirect, Google Scholar) identified five relevant articles. Study quality, rated by means of a modified Downs & Black checklist, was moderate to high (average: 13.5/16 points). Four of five papers, in at least one parameter, found either an association of lower PGF and reduced task safety or significantly reduced task safety in low vs. high PGF performers. Yet, as a) the outcomes, populations and statistical methods of the included trials were highly heterogeneous and b) only two out of five studies had an adequate control condition (pre-planned movement task), evidence was classified as conflicting. In sum, PGF may represent a factor increasing injury risk during unplanned sports-related movements but future research strengthening the evidence of this association is warranted.

scholarly journals Perceptual–Cognitive Function and Unplanned Athletic Movement Task Performance: A Systematic Review

2020 ◽  
Vol 17 (20) ◽  
pp. 7481
Author(s):  
Jan Wilke ◽  
David Groneberg ◽  
Winfried Banzer ◽  
Florian Giesche
Keyword(s):  
Systematic Review ◽  
Cognitive Function ◽  
Task Performance ◽  
Lower Limb ◽  
Injury Risk ◽  
Future Research ◽  
Functional Safety ◽  
Study Quality ◽  
And Performance ◽  
Cutting Direction

The performance of choice-reaction tasks during athletic movement has been demonstrated to evoke unfavorable biomechanics in the lower limb. However, the mechanism of this observation is unknown. We conducted a systematic review examining the association between (1) the biomechanical and functional safety of unplanned sports-related movements (e.g., jumps/runs with a spontaneously indicated landing leg/cutting direction) and (2) markers of perceptual–cognitive function (PCF). A literature search in three databases (PubMed, ScienceDirect and Google Scholar) identified five relevant articles. The study quality, rated by means of a modified Downs and Black checklist, was moderate to high (average: 13/16 points). Four of five papers, in at least one parameter, found either an association of PCF with task safety or significantly reduced task safety in low vs. high PCF performers. However, as (a) the outcomes, populations and statistical methods of the included trials were highly heterogeneous and (b) only two out of five studies had an adequate control condition (pre-planned movement task), the evidence was classified as conflicting. In summary, PCF may represent a factor affecting injury risk and performance during unplanned sports-related movements, but future research strengthening the evidence for this association is warranted.

Acute limb ischemia in a patient with pre-fibrotic myelofibrosis complicated by heparin-induced thrombocytopenia and thrombosis – case report and systematic review of dabigatran use

VASA ◽  
2020 ◽  
pp. 1-6 ◽  
Author(s):  
Marina Di Pilla ◽  
Stefano Barco ◽  
Clara Sacco ◽  
Giovanni Barosi ◽  
Corrado Lodigiani
Keyword(s):  
Systematic Review ◽  
Case Report ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Review Of The Literature ◽  
Heparin Induced Thrombocytopenia ◽  
Lower Limb Ischemia ◽  
Vein Thrombosis ◽  
Left Lower Limb

Summary: A 49-year-old man was diagnosed with pre-fibrotic myelofibrosis after acute left lower-limb ischemia requiring amputation and portal vein thrombosis. After surgery he developed heparin-induced thrombocytopenia (HIT) with venous thromboembolism, successfully treated with argatroban followed by dabigatran. Our systematic review of the literature supports the use of dabigatran for suspected HIT.

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